具有挑战性的轻度缺氧缺血性脑病:对神经预后的见解。

IF 1.7 Q3 PEDIATRICS
Mustafa Canbeldek, Coşkun Armağan, Hüseyin Bahadır Şenol, Hüseyin Burak Baykara, Ayşen Bahar Baykara, Handan Güleryüz Uçar, Uluç Yiş, Funda Tüzün Erdoğan, Nuray Duman, Hasan Özkan
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引用次数: 0

摘要

目的:本研究旨在评估诊断为轻度缺氧缺血性脑病(HIE)的新生儿的长期神经预后,并将其与中/重度病例进行比较,假设相当比例的轻度HIE病例可能会出现不良的神经发育后遗症。材料和方法:这是一项横断面观察性研究,评估轻度与中度/重度HIE新生儿的神经发育结局。记录了产妇、围产期和新生儿的特征以及治疗情况。通过脑MRI、安卡拉发育筛查量表(ADSI)和发育里程碑评估神经系统预后。结果:共纳入42例患儿,其中轻度HIE 20例(47.6%),中重度HIE 22例(52.4%)。基线特征相似,除了中/重度病例的1分钟Apgar评分较低(中位数4比6;P = 0.02)和更频繁需要高级复苏(68%比25%;P = 0.006)。所有中度/重度婴儿都接受了TH治疗,而轻度组没有。有创机械通气和辅助神经保护剂在中/重度组也更常用。与HIE相符的磁共振成像异常在轻度病例中占2/12(16.7%),在中/重度病例中占8/19(42.1%)。两组间HIE损伤类型差异无统计学意义(P = 0.197)。在ADSI筛查中,8/12(66.7%)轻度HIE幸存者表现为大运动延迟,而5/7(71.4%)中度/重度幸存者表现为大运动延迟。结论:即使是轻度HIE患儿也存在不良神经预后的风险。更敏感的诊断工具的发展可以改善治疗策略和早期干预,最终影响预后。通过适当的识别,量身定制的随访和适当的治疗方法,可以减轻轻度HIE病例中潜在的神经发育障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Challenging Mild Hypoxic-Ischemic Encephalopathy: Insights Into Neurological Outcomes.

Challenging Mild Hypoxic-Ischemic Encephalopathy: Insights Into Neurological Outcomes.

Challenging Mild Hypoxic-Ischemic Encephalopathy: Insights Into Neurological Outcomes.

Objective: This study aims to evaluate the long-term neurological outcomes of neonates diagnosed with mild hypoxic-ischemic encephalopathy (HIE) and compare them with moderate/ severe cases, hypothesizing that a significant proportion of mild HIE cases may experience adverse neurodevelopmental sequelae. Materials and Methods: This was a cross-sectional observational study evaluating the neurodevelopmental outcomes of neonates with mild versus moderate/severe HIE. Maternal, perinatal, and neonatal characteristics along with treatments were documented. Neurological outcomes were assessed via brain MRI, the Ankara Developmental Screening Inventory (ADSI), and developmental milestones. Results: The study included 42 infants, 20 (47.6%) were classified as having mild HIE and 22 (52.4%) as moderate/severe HIE. Baseline characteristics were similar except that moderate/ severe cases had lower 1-minute Apgar scores (median 4 vs. 6; P = .02) and more frequent need for advanced resuscitation (68% vs. 25%; P = .006). All moderate/severe infants received TH vs. none in the mild group. Invasive mechanical ventilation and adjuvant neuroprotective agents were also more frequently used in the moderate/severe group. Magnetic resonance imaging abnormalities consistent with HIE were present in 2/12 mild cases (16.7%) vs. 8/19 (42.1) in moderate/severe cases. There were no significant differences in HIE injury pattern between the 2 groups (P = .197). On ADSI screening, 8/12 (66.7%) mild HIE survivors showed gross motor delay compared with 5/7 (71.4%) moderate/severe survivors. Conclusion: Even infants with mild HIE are at risk of adverse neurological outcomes. The development of more sensitive diagnostic tools could improve treatment strategies and early interventions, ultimately impacting prognosis. With proper recognition, tailored follow-up, and appropriate therapeutic approaches, potential neurodevelopmental impairments in mild HIE cases could be mitigated.

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